Why is ACA the Answer?

We are in broad agreement on major issues: The US citizenry demands health care for free. Politicians are happy to oblige by borrowing from our children. Health care costs have been on an unsustainable path, so they won't be sustained. The end will be violent, bloody and painful, like Greece, or we'll exhaust all options before doing the right thing.

But tell me again, why is the ACA the right thing? Forget about the Constitutionality for a second. What about the ACA will fix the problems you have identified? It seems to me it makes it worse. It taxes, or penalizes the young and healthy in order to subsidize care for the old and infirm. Frankly, I don't know why the young are so meek about it. If your answer is IPAB, isn't that Palin's Death Panel?

I think both political parties are equally culpable in this wealth transfer from our children to ourselves and they are doing it for one simple reason: old people elect them to do so.

You are absolutely correct, we ration now. But from my perspective, most everything is rationed. A person or household has a budget constraint and rations his/their purchases based on that constraint. Except when it comes to health care. It's not rationed because we as a country have deluded ourselves into believing that because we paid taxes for the past forty years we deserve unlimited care for the next twenty, as if it really were an insurance or annuity plan. If you call a dog's tail a leg, the dog still only has four legs. And if you call a wealth transfer scheme an insurance program it's still a wealth transfer scheme.

You and I both know Medicare must end as we know it. With ACA, the IPAB and other mechanisms will impose rationing from without. With Ryan's plan the rationing will come from the individual. I believe the former will be arbitrary and driven by the politics of shouting. For example, the Catholic Church forced to violate its conscience or give up its good works. I believe the latter will have a better chance of encouraging new services and delivery mechanisms. So yes, I want to end Medicare as we know it. But that's going to happen anyway.

The ACA is not dead yet. Far from it. And I'm not convinced the Supreme Court will rule it, or the mandate unconstitutional. Yogi Berra is quoted as saying, "When you come to a fork in the road, take it." Lawyers are kind of like that. When they come to a fork in the road, they make a new road. We'll see what the Court does. In some ways I'd prefer chaos. Strike down the mandate, keep all else. Congress would be forced to act. After it exhausted all other options.